SGE50017Q0094_final.pdf

U.S. Department of State RFP #: SGE50017Q0094 American Embassy Tunisia Health Insurance Services

HEALTH INSURANCE SERVICES

U.S. DEPARTMENT OF STATE

AMERICAN EMBASSY TUNISIA

RFQ # SGE500-17-Q-0094

AMERICAN CONSULATE GENERAL

REGIONAL PROCUREMENT SUPPORT OFFICE

GIESSENER STRASSE 30

60435 FRANKFURT AM MAIN

GERMANY

U.S. Department of State RFP #: SGE50017Q0094 American Embassy Tunisia Health Insurance Services

TABLE OF CONTENTS

(a) Standard Form (SF) 1449

(b) Continuation from SF 1449

1. Schedule of Supplies/Services

2. Description/Specification/Work Statement

3. Packing and Marking

4. Inspection and Acceptance

5. Deliveries or Performance

6. Contract Administration Data

7. Special Contract Requirements

(c) Contract clauses

1. FAR and DOSAR Clauses Incorporated by Reference

2. FAR and DOSAR Clauses Included in Full Text

(d) Any contract documents, exhibits or attachments

1. Reserved

(e) Solicitation provisions

1. 52.212-1, Instructions to Offerors -- Commercial Items

2. Addendum to 52.212-1;

3. 52.212-2, Evaluation -- Commercial Items

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

SGE50017Q0094

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

08/ /2017

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

c. EMAIL @state.gov

8. OFFER DUE DATE / LOCAL

TIME

09/11/2017 12:00:00

CODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

FRANKFURT, 60435

GERMANY

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS: 524114

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

13b. RATING

X RFQ IFB RFP

14. METHOD OF SOLICITATION

CODE15. DELIVER TO

AMERICAN EMBASSY TUNIS

1053 LES BERGES DU LAC

ATTN: GSO/PROC

TUNIS

TUNISIA

CODE16. ADMINISTERED BY

FACILITY

CODE

CODE

Contact Duns Telephone No.

17a. CONTRACTOR/OFFEROR CODE18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY TUNIS

1053 LES BERGES DU LAC

ATTN: FMC

TUNIS

TUNISIA

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER X SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Line Items Section

25. ACCOUNTING AND APPROPRIATION DATA

See Line Item Detail

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCES FAR 52.212-1, 52.212-4, FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4, 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. OFFER DATED . YOUR OFFER ON

SOLICITATION (BLOCK 5) INCLUDING ANY ADDITIONS OR CHANGES WHICH

ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR

PRINT)

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

Page

SGE50017Q0094

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 02/2012) BACK

001 BASE YEAR

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

0001A: Single Employees (Self Only) 0001B: Family Plan Employees 0001C: Retirees 0001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2017 to 10/22/2018

1001 OPTION YEAR 1

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

1001A: Single Employees (Self Only) 1001B: Family Plan Employees 1001C: Retirees 1001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2018 to 10/22/2019

2001 OPTION YEAR 2

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

2001A: Single Employees (Self Only) 2001B: Family Plan Employees 2001C: Retirees 2001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2019 to 10/22/2020

3001 OPTION YEAR 3

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

3001A: Single Employees (Self Only) 3001B: Family Plan Employees 3001C: Retirees 3001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2020 to 10/22/2021

4001 OPTION YEAR 4

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

4001A: Single Employees (Self Only) 4001B: Family Plan Employees 4001C: Retirees 4001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2021 to 10/22/2022

5001 6-MONTH OPTION TO EXTEND

Embassy Tunisia - Health Insurance Services

0.00 LT

This CLIN in inclusive of the following Sub-CLINs:

Page

SGE50017Q0094

Line Item Summary

Solicitation Number:

SGE50017Q0094

Contract Number: Title: US Embassy Tunisia - Health Insurance Services

Date of Solicitation:

08/17/2017

Line Item No. Description Quantity Unit Unit Price Total Cost

5001A: Single Employees (Self Only) 5001B: Family Plan Employees 5001C: Retirees 5001D: Other Direct Costs

Doc Ref No:

Delivery Date (Start to End) Date FOB:

10/23/2022 to 04/22/2023

Page

SGE50017Q0094

Line Item Summary

Solicitation Number:

SGE50017Q0094

Contract Number: Title: US Embassy Tunisia - Health Insurance Services

Date of Solicitation:

08/17/2017

Line Item No. Description Quantity Unit Unit Price Total Cost

Identifier Title Date Number of Pages

(b) SF1449 CONTINUATION PAGES

1.0 SCHEDULE OF SUPPLIES/SERVICES

1.1 OVERVIEW

The mission of the U.S. Embassy in Tunisia is to support Tunisia as it works to consolidate its nascent democracy, develop its eco-nomy and strengthen its security capacity. This contract supports U.S. Embassy Tunisia by providing health insurance services to loc-ally-hired employees and retirees of the U.S. Government (USG) in Tunisia as described in Section 2.0.

1.2 TYPE OF CONTRACT

a) This is an indefinite-delivery, indefinite-quantity (IDIQ) contract, as defined in Federal Acquisition Regulation (FAR) 16.504 (Indefinite-Quantity Contracts) for commercial items.

b) Tasks or work to be performed will be identified at the task order level.

c) Task orders will utilize fixed-price (see FAR Subpart 16.2) contract types with economic price adjustments. Task orders will also include cost-reimbursable line items for other direct costs (e.g., value added tax and Defense Base Act Insurance).

d) If a task order will be performance-based, as described in FAR subpart 37.6 (Performance-based Acquisition), its requirements will be conveyed and administered at the task order level.

1.3 MINIMUM AND MAXIMUM CONTRACT QUANTITIES

a) The Government shall meet the contract minimum of $5,000 (inclusive of all direct costs, indirect costs, and profit/fee) through the issuance of task order(s) within the contract’s period of performance.

b) The maximum quantity for the contract’s period of performance, including any extension(s), shall be any quantity or combination of supplies and services not exceeding $1,500,000.00 (inclusive of all direct costs, indirect costs, and profit/fee).

1.4 PRICING

BASE YEAR

Identifier Status Number of Employees Contribution/Unit Cost Subtotal 0001A Single Employees (Self

Only) 0001B Family Plan Employees 0001C Retirees 001D Other Direct Costs (e.g., Insurance Tax, Defense Base Act Insurance)

Base Year Total

Page

SGE50017Q0094

The Contractor will be paid the full amount by the Government. The Government is responsible for collecting Employee Contributions.

Bi-Weekly Rate per Employee (Base Year Total Divided by 26): _____________

OPTION YEAR 1

Identifier Status Number of Employees Contribution/Unit Cost Subtotal 1001A Single Employees (Self

Only) 1001B Family Plan Employees 1001C Retirees 1001D Other Direct Costs (e.g., Insurance Tax, Defense Base Act Insurance)

Option Year 1 Total

Bi-Weekly Rate per Employee (OY 1 Total Divided by 26): _____________

OPTION YEAR 2

Identifier Status Number of Employees Contribution/Unit Cost Subtotal 2001A Single Employees (Self

Only) 2001B Family Plan Employees 2001C Retirees 2001D Other Direct Costs (e.g., Insurance Tax, Defense Base Act Insurance)

Option Year 2 Total

Bi-Weekly Rate per Employee (OY 2 Total Divided by 26): _____________

OPTION YEAR 3

Identifier Status Number of Employees Contribution/Unit Cost Subtotal 3001A Single Employees (Self

Only) 3001B Family Plan Employees 3001C Retirees 3001D Other Direct Costs (e.g., Insurance Tax, Defense Base Act Insurance)

Option Year 3 Total

Bi-Weekly Rate per Employee (OY 3 Total Divided by 26): _____________

OPTION YEAR 4

Identifier Status Number of Employees Contribution/Unit Cost Subtotal 4001A Single Employees (Self

Only) 4001B Family Plan Employees 4001C Retirees 4001D Other Direct Costs (e.g., Insurance Tax, Defense Base Act Insurance)

Option Year 4 Total

Bi-Weekly Rate per Employee (OY 4 Total Divided by 26): _____________

SUMMARY PRICING

Identifier Total Estimated Price Base Year

Option Year 1 Option Year 2 Option Year 3 Option Year 4

Grand Total

1.5 DEFENSE BASE ACT (DBA) INSURANCE

a) DBA Insurance costs are unallowable for performance in the United States.

b) DBA Insurance costs are generally allowable for performance outside the United States, but only for covered Contractor and sub-contractor employees. The following are covered Contractor and subcontractor employees: 1) United States citizens or residents; 2) Individuals hired in the United States or its possessions, regardless of citizenship; and 3) Local nationals and third country nationals where task order performance takes place in a country where there are no local worker’s compensation laws.

c) In addition, DBA Insurance costs are generally allowable for performance outside the United States, but only when such costs ac-cord with the terms of the Contractor’s DBA Insurance policy, law, and regulation.

d) The Contractor’s DBA Insurance policy shall be with a carrier approved by the United States Department of Labor to provide DBA Insurance, or the Contractor shall be a self-insured employer authorized by the United States Department of Labor to provide DBA In-surance.

1.6 ECONOMIC PRICE ADJUSTMENT -- HEALTH INSURANCE PREMIUMS

a) Premium Adjustment based on Experience - For health insurance, prices may be adjusted upward or downward based on the experi-ence rating of the Mission(s) covered by this contract. NO adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis. Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period: (1) re-ceipts (premiums received) minus the retention amount and (2) claims paid. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Any failure to reach agreement under this clause shall be subject to the procedures in the Dis-putes clause.

b) Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the contractor to perform this con-tract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the Contractor to modify the con-tract to adjust the premium rate. The contractor agrees to provide all documentation necessary to support any requested adjustment.

c) Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the Contractor must include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

1.7 PERIOD OF PERFORMANCE

This contract is comprised of a one-year base period, and four, one-year option periods (plus a six-month option to extend in accord-ance with FAR 52.217-8).

Base Year: To be completed at time of award Option Year 1:

Option Year 2:

Option Year 3:

Option Year 4:

2.0 DESCRIPTION/SPECIFICATION/WORK STATEMENT

2.1 HEALTH INSURANCE SERVICES

The U.S. Department of State (hereinafter referred to as “DOS”, “the Department”, or “State”) requires Health Insurance coverage for its employees in Tunisia, as further described in Section. The Department has determined that the prevailing practice by employers in Tunisia is to provide for their employees. The specific health benefit coverage is set forth in this Section.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by the Contracting Officer.

2.1.1 Employee and Dependent Health Services Benefits

2.1.1.1 Hospitalization

100% reimbursement of room and board for a ward room or semi-private room. 80% reimbursement of room and board for a private room, not to exceed 100% of the cost of a semi-private room. 100% reimbursement of hospital medical expenses including laboratory tests and x-rays, nursing care, operating room costs, intensive care, prescription medicines, and physical therapy. 100% reimburse-ment of ambulance service.

2.1.1.2 Professional Services and Treatment

80% reimbursement of doctors’ and surgeons’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doc-tor’s office, or at home. 90% reimbursement for medical services and expenses when not hospitalized such as laboratory tests and x-rays, prescription medicines, physical therapy, routine annual physical examination, and inoculations.

2.1.1.3 Prescription Drugs and Medicines

100% reimbursement when hospitalized, and 90% reimbursement when not hospitalized, of the cost of medicines and drugs for which a prescription is legally required. Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

2.1.1.4 For Employees Only

100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS. For employee and employee's covered spouse/partner: 100% reimbursement for brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child. This expanded coverage generally excludes medications for the long-term suppression of aids through the combination of anti-retroviral drugs at those posts with inadequate local healthcare infrastructures.

The maximum limit for expenses reimbursed under section 2.1.1.4. is 6,350 TND per patient per contract year. This limit also will be prorated for employees regularly scheduled to work on a part-time basis for fewer than 30 hours per week.

2.1.1.5 Obstetrical Care

Obstetrical care: 90% real costs (frais reels) with no limit for prenatal and postnatal as these costs are included under medical care (soins medicaux). Note: Fee for circumcision come under Medical Services in 2.1.1.1 and 2.1.1.2 above.

2.1.1.6 Family Planning

80% reimbursement of prescribed contraceptive devices and drugs, voluntary sterilization, and diagnosis and treatment of infertility.

Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, fertility drugs, and assisted reproductive technology.

2.1.1.7 Hearing Aids

80% reimbursement of the cost of a hearing aid apparatus and related examination. Limited to one apparatus per year per patient in a three-year period.

2.1.1.8 Optical Care

95% reimbursement for eye examination and treatment and prescription eyeglasses or contact lenses. Limited to two lenses per patient every two years. For the frames 90% real costs (frais reels) with a 200.00 Tunisian Dinar limit each 2 years. No reimbursement for non-prescription lenses, or tinting.

2.1.1.9 Dental Care

50% of expenses for dental services including dentists’ fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. Orthodontia treatment is covered only if treatment begins before age 15, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient.

2.1.1.10 Psychiatric Treatment

50 % reimbursement for psychiatric treatment if prescribed as necessary by a medical professional. No coverage for ad hoc personal psychiatric treatment.

2.1.1.11 Medical Expenses Incurred Out of Country

Medical expenses incurred out of country will not be covered.

2.1.1.12 Transportation for Out of Country Treatment

Transportation for out of country treatment is not a covered expense.

2.1.1.13 Annual Maximum Limit

The maximum annual reimbursement per patient per contract year, not including expenses covered under 2.1.1.4, is TND 6,350 per patient per contract year. There is no limit on the number of dependents. Note: The maximum limit for part-time employees regu-larly scheduled to work for fewer than 30 hours per week will be prorated based on hours in the workweek. For example, the maxim-um limit for an employee regularly scheduled to work 20 hours per week is TND 6,350 X 20 divided by 40, equals to TND 3,175.

2.1.2 Eligible Participants

Tables 2.1.2(a) and 2.1.2(b) show the estimated number of persons that the Contractor will be required to support. These numbers are based on a best estimate and are subject to change. The Contractor shall plan for a -/+ variance of 5%. Anything above or below 5% will be reflected with a change to the contract issued by the Contracting Officer.

Table 2.1.2(a): Employee Statistics

Category Estimated Number of Persons Single Employees 37

Family Plan Employees 247 Family Dependents 523

Retirees 47 Retirees’ Dependents 53

Table 2.1.2(b): Official Residence Expense (ORE) Employees Rider

Category Estimated Number of Persons Single Employees 2

Family Plan Employees 6 Family Dependents 12

2.1.2.1 Eligible Employees

The employees eligible for the health insurance services include the following:

a) All current active employees of the United States Government, employed within the geographic boundaries of Tunisia paid under the Local Compensation Plan, and certified by the Contracting Officer.

b) Foreign Service Nationals (FSNs) employed as direct hires;

c) FSNs employed under Personal Services Agreements (PSAs);

d) FSNs employed under Personal Services Contracts (PSCs);

e) Third country nationals (TCNs) employed as direct hires;

f) TCNs employed under PSAs;

g) TCNs employed under PSCs;

h) Locally hired U.S. citizens employed as direct hires; and

i) Locally hired U.S. citizens employed under PSCs.

j) Retirees: There will be coverage for retired employees at the prevailing annual insurance premium which must equal that for em-ployees: USG will pay 50% of the premium, and the Retiree 50%. (Currently Post has 30 Retirees).

Note: Reimbursement for medical coverage for Retirees is strictly limited to medical services incurred within the geographical area of Tunisia, not overseas.

2.1.2.2 Location of Employment

The individuals covered by 2.1.2.1 must be employed within the geographic boundaries of Tunisia by:

a) United States Department of State

b) United States American Battlefields and Monuments Commission (ABMC)

c) United States Department of Defense

d) United States Department of Agriculture

e) United States Department of the Treasury

f) United States Department of Commerce

g) Any other United States Agency where staff under above-mentioned 2.1.2.1 Eligible Employees, come under Chief of Mission (COM) authority.

2.1.2.3 Participants Covered Under a Rider

All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE (Official Residence Expense) account. All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

2.1.3 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are Peace Corps Personal Services Contractors as required by MS 743; em-ployees working on a temporary basis; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; parents or siblings of employees hired after October 22, 2012 and any other individual not falling within one of the categories of employees described in this clause.

2.1.3.1 Other Eligible Participants

Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, or stepchild. The child must be unmarried, economically de-pendent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 21 if a full time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit to the number of children covered per employee.

a) There will be coverage for retired employees’ dependents at the prevailing annual insurance premium which must equal that for em-ployees. If a Retiree passes away, the surviving spouse has the right to continue coverage at the same costs. If a Retiree or surviving spouse remarries, the new spouse will not be covered. Only those dependents listed at the time of the employee’s retirement will be covered.

b) Reimbursement for medical coverage for Retirees’ dependents is strictly limited to medical services incurred within the geographic-al area of Tunisia, not overseas.

c) A parent or sibling who is financially dependent upon the employee and who is registered as a dependent of the employee for the sake of CNSS (local Social Security) or CSR (Civil Service Retirement plan) contributions hired before 2012.

2.1.4 Eligibility

2.1.4.1 Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the perform-ance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government.

An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

2.1.4.2 Period of Ineligibility

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of Leave Without Pay or unpaid leave that is one pay period or less, coverage under the insurance contract will con-tinue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

During a period of extended (beyond one pay period) of Leave without Pay or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

2.1.4.3 Health Benefits Conditions and Limitations

The Government of Tunisia follows the practice of identifying certain types of treatment by code. The Contractor shall reimburse the costs at the percentage levels indicated in Section 2.1.1 maximum limits as set forth under Employee and Dependent Health Services Benefits.

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilit-ative therapy; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance;

fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

Other conditions and limitations on the entitlement to health care under this contract are as follows:

Excluded are the following and any accidents/illnesses resulting from them:

a) Alcoholism, drunkenness, and the usage of drugs or medications that were not medically prescribed, and any resultant disease or sickness;

b) Civil or foreign war, or use or possession by the insured of any apparatus or weapon of war;

c) Strikes, uprisings, popular movements, acts of terrorism or sabotage;

d) Suicide or suicide attempts or participation in any professional sport, by the insured. Also, participation in any brawl by the insured except in the case of legitimate self-defense;

e) Aspirin, quinine, dietary or body-building products, or vitamins, except those prescribed by a physician for treatment following ill-ness;

f) Thermometers, cotton, syringes, except if these products are prescribed by a physician for treatment following an illness;

g) All products not of therapeutic character;

h) Treatment linked to previously existing conditions;

i) Rejuvenation treatments and other beauty treatments;

j) Physical rehabilitation, or orthopedic intervention, unless needed due to the consequences of an accident or illness while covered by the policy;

k) Personal expenses incurred during hospital stays;

l) Voluntary interruptions of pregnancy;

m) Rehabilitation expenses or physical therapy without the authorization of the insurance company’s consultant physician, unless these expenses are the result of an accident or illness;

n) Massage therapy, heat or hydrotherapy, exercise therapy, manicure and pedicure

o) Diseases due to radioactive, nuclear or X-ray exposure;

p) Congenital deformities;

q) Spa or thermal cures;

r) Preexisting conditions—after-effects of accidents, infirmities and illnesses on the effective date of the contract or on the date of ad-mission of an employee to the insurance plan, are guaranteed cover under the following dual conditions:

1) That such affections have been declared in response to the medical questionnaire for the insurance proposal;

2) That such affections have not been excluded under the scheme and are accepted under the conditions fixed by the insurance com-pany.

In the event of non-declaration of infirmities or known congenital diseases, diseases and accidents occurring prior to the effective date of contract or date of admission of a newly insured staff, the beneficiary will be liable to sanctions stipulated for non-adherence to de-claration obligations (non-guaranteed by the insurance).

There is no reimbursement for expenses that will be reimbursed or paid directly under a workers’ compensation program; the U.S.

workers’ compensation program or post’s LES workers’ compensation program.

Employees and retirees are not obliged to use the national health care system first. They may choose to use their private health insur-ance or the national health care system. If they would like to use both, they must first go through the national health care system and their private health insurance would be a complementary reimbursement.

No reimbursement for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the prac-tice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces an any country.

No reimbursement for medical expenses incurred outside of Tunisia. There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

2.1.5 Brochure Requirement

a) The Contractor shall provide a document (brochure/pamphlet/other written document) in English, French and Arabic that sets forth a complete listing of the health insurance benefits to be provided under this contract. Any exclusion to pre-existing conditions not covered by the benefits and conditions set by the contractor shall be included in the brochure. This brochure shall be provided in suffi-cient quantities so that each covered employee receives a copy. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

b) The Contractor shall provide the Brochure to the COR not later than fifteen (15) days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

c) The contractor assumes full responsibility for ensuring that Brochure accurately reflects the requirements of the contract, as imple-mented by the contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the bro-chure contains inaccuracies, the contractor will be notified in writing; however, failure on the part of the Government to notice any in-accuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the contractor to fully comply with all contract terms.

2.1.6 Contractor Responsibility in Claims and Reimbursement to Claimants

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervi-sion, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthor-ized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

Administrative Records.

a) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

b) The Contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the con-tract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

c) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

d) The Contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee or documenta-tion supporting electronic funds transfer (EFT) has been processed not later than the Tuesday which is two weeks after the claim has been submitted.

Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

a) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims, along with a claim report which includes date of care, employee’s name, insurance number and amount, are delivered to the Contract-or by the COR three times per month.

b) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or in-formation thereby disallowing said claim to be payable, the Contractor shall notify the COR within seven calendar days of receipt of claim of any missing documents or information and the COR will then notify the employee (if notification is written).

c) The contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

d) Settlement of medical insurance shall be by electronic funds transfer (EFT) in the name of the employee for each claim submitted.

The Contractor is required to send a form to the COR providing details of the amount reimbursed with an explanation of deductions, if any.

e) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in or-der that the Contractor will pay the expenses directly to the hospitals.

f) Tunisian law requires that injuries arising from work accidents be treated at designated hospitals and clinics. The US government requires that there be no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers’ compensation program, or a post’s LES workers’ compensation program. If an employee injured in a work accident chooses to go to a non-CNSS state-run hospital or clinic for treatment, that employee will NOT be covered by the FSN health plan, but will only be reimbursed by CNSS in accordance with prevailing practice.

2.1.7 Report Requirements

The Contractor shall provide the following reports three times per month, on the 10th, 20th and 30th. These reports shall report on the previous 10 days' activities.

a) Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims, a brief descrip-tion of why claim has not been paid, and why deductions have been made.

2.2 DEFINITIONS

FMO

The Financial Management Officer or the paying office for all U.S. Government Agencies except AID.

Clinic An institution, either privately or state-run, established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this defini-tion is not considered a Clinic.

Clinic Patient An individual who has been admitted to a hospital, is assigned a bed, and given diagnostic tests or receives treatment for a disease or an injury.

CNSS Clinic

These are Clinics, as above (see Clinic), which, along with state-run hospitals, are also state-run and are the only Clinics which should be used for injuries resulting from a Work Accident. Individuals who suffer a serious work accident can also use the hospital emer-gency services.

COR

Contracting Officer's Representative (Human Resources Officer at post).

Contributory Insurance for which the employee contributes towards the premium.

Dependent Participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the em-ployee’s natural child, adopted child, or stepchild. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 22 if a full time student. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit of numbers of children covered per employee.

Disability, Total and Permanent A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and requires sep-aration from employment. If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section 2.0 for health insurance. This may also include an ORE Staff if this category of individual is an eligible participant, as defined in Section 2.0 for health insurance.

Employer The United States Government or in the case of ORE the Chief of Mission/Deputy Chief of Mission.

GSO

General Services Officer in charge of the General Services Office at post.

Hospital or Sanatorium State-run institutions established and operated for the generalist and specialist care and treatment of sick and injured persons, or per-sons with chronic illness, such as Tuberculosis, or specialist hospitals for children, or eye care, etc. These hospitals and sanatoria provide 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet definition is not considered a hospital or sanatorium.

Hospital Patient An individual who has been admitted to a hospital, or specialist sanatorium, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses.

Customary and Reasonable Treatment A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

Retiree An employee who has ceased work at the age prevailing by local law in accordance with local law, and/or by agreement with or 60, 62

Surgical Procedure Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

3.0 PACKING AND MARKING

3.1 MARKING OF REPORTS

All reports delivered by the Contractor to the Government under this contract shall prominently show on the cover of the report:

a) Name and address of the Contractor;

b) Contract and task order number(s);

c) Date of report; and

d) Program office(s)

The Contractor shall not include any company watermarking or statement that would prevent the Government from utilizing or circu-lating the information contained in the report. If there are issues with the potential proprietary nature of the information, it shall be brought to the attention of the Contracting Officer for resolution.

Unless otherwise requested at the task order level, reports shall be submitted electronically to the contract administration personnel identified in Section 6.0.

3.2 SHIPPING INSTRUCTIONS

Supplies shall be packed for shipment in a manner that will ensure acceptance by common carriers and safe delivery at destination.

3.3. LATE DELIVERY

The Contractor shall notify the COR, GTM, Program Officer, or other authorized representative designated in each task order as soon as it becomes apparent to the Contractor that a scheduled delivery will be late. The Contractor shall include in the notification the ra-tionale for late delivery, the expected date for the delivery and the project impact of the late delivery. Such notification in no way lim-its the Government’s right to any and all rights and remedies including termination.

4.0 INSPECTION AND ACCEPTANCE

4.1 ACCEPTABLE LEVELS OF PERFORMANCE

a) The Contracting Officer and his/her representatives are responsible for inspection and acceptance of the Contractor’s effort under this contract. The COR(s) and GTM(s) will review all deliverables for their completeness, accuracy, format, and acceptable content.

The Contractor shall correct any deficiencies as directed by the COR and/or GTM and shall resubmit the deliverable no later than a mutually-agreed upon date.

b) The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

4.2 QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor contractor performance, advise the contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The contractor, not the USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective Performance Threshold

Timely payment of benefits (within 21 calendar days) No more than one (1) customer complaint is received per month.

No incorrectly denied claims No more than one (1) customer complaint is received per month.

4.2.1 COMPLAINT PROCEDURES

a) If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

b) The COR will complete appropriate documentation to record the complaint.

c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his / her files.

d) If the COR determines the complaint is valid, the COR will inform the contractor and give the contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

e) The COR shall, as a minimum, provide e-mail notification informing the contractor of any valid complaints.

f) If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. The COR will review the matter to determine the validity of the complaint.

g) The COR will consider complaints as resolved unless notified otherwise by the complainant.

h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

5.0 DELIVERIES OR PERFORMANCE

5.1 PERIOD OF PERFORMANCE

This contract is comprised of a one-year base period and four, one-year option periods.

The Contracting Officer may extend the term of the contract up to an additional six months in accordance with FAR Clause 52.217-8 (Option to Extend Services), which is contained in Section I of this contract.

5.2 DELIVERABLES

The Contractor shall provide the following deliverables in the timeframe and format prescribed. The Contracting Officer shall notify the Contractor in writing of any additional deliverables that may arise during contract performance. All delivery times are measured from the effective date of the contract. The table below defines all the relevant Contractor deliverables. With regard to the Contractor-produced reports required in the table below, the Government will have 20 business days to review the deliverable documents, either accepting them as is or returning them to the Contractor with feedback and requesting action. If the Government returns the document requesting correction, the 20 day review calendar cycle applies to each subsequent document version review. If the Government does not respond within 20 business days, the Contractor may consider the document deliverable as accepted.

Reference Deliverable Due Date (calendar days unless otherwise specified)

Section 2.1.5 Brochures • 15 Days after Contract award

• Additional Brochures for new em-ployees within 10 days of the COR’s Request

• Updates made on as-needed basis

Section 2.1.7 Employee Claims Report • On the 10th, 20th, and 30th of the Month

Management Plan • Updated within 20 days after con-tract award

Section 4.0 Quality Assurance • As required by Section 4.0

Section 6.3 Invoicing • Sample invoice submitted to COR and CO within 10 business days of contract award.

• Invoices submitted to DOS within 30 days after the end of the billing month.

Section 6.5 Final Invoice

• A full and accurate inventory, ac-counting for all lost, stolen or dam-aged property must be furnished to the COR before final payment is authorized.

6.0 CONTRACT ADMINISTRATION DATA

6.1 CONTRACT ADMINISTRATION

This contract will be administered as follows:

Contracting Officer (CO) To Be Provided at Contract Award U.S. Department of State Regional Procurement Support Office (RPSO) Frankfurt

Contracting Officer’s Representative (COR) To Be Provided at Contract Award U.S. Department of State American Embassy Tunisia

Written communications regarding the administration of this contract shall make reference to the contract number, applicable task or-der number(s) and shall be submitted electronically to the CO and COR.

6.1.1 CONTRACTING OFFICER

The Contracting Officer (CO) has sole authority to modify the terms of this contract. The Contractor is responsible for ensuring that all deviations from contract requirements are approved by the CO.

6.1.2 CONTRACTING OFFICER'S REPRESENTATIVE

The Contracting Officer will designate in writing one or more Government employees or Personal Service Contractors (PSCs), by name and position title, to take action for the Contracting Officer under this contract. Each designee shall be identified as a Contract-ing Officer’s Representative (COR) or Alternate Contracting Officer’s Representative (ACOR). Such designation(s) shall specify the scope and limitations of the authority so delegated.

6.2 TECHNICAL DIRECTION

Contract performance shall be subject to technical instructions, whether oral or written, issued by the COR specified in Section 6.1.

Technical instructions must be within the general scope of work stated in the contract. Technical instructions may not be used to:

a) Assign additional work or reduce work under the contract.

b) Direct a change as defined in the "Changes" clause of this contract.

c) Increase or decrease the contract price or estimated contract amount (including fee), as applicable, the level of effort, or the time re-quired for contract performance.

d) Change any of the terms, conditions or specifications of the contract.

If, in the opinion of the Contractor, any technical instruction calls for effort outside the scope of the contract or is inconsistent with this requirement, the Contractor shall notify the Contracting Officer in writing within two (2) calendar days after the receipt of any such instruction. The Contractor shall not proceed with the work affected by the technical instruction unless and until the Contractor is notified by the Contracting Officer that the technical instruction is within the scope of this contract or a change order is issued.

Nothing in this section shall be construed to excuse the Contractor from performing that portion of the contractual work statement that is not affected by the disputed technical instruction.

6.3 INVOICE INSTRUCTIONS

To constitute a proper invoice, the Contractor shall provide the following:

a) Submit two separate invoices: one for the ORE Staff and one for the remainder. The invoices shall be submitted to:

American Embassy - Ambassade des Etats Unis d’Amerique Financial Management Officer Les Berge du Lac 1053-Tunis Tunisia

b) The invoice shall include a listing of each service and supply according to the CLIN and sub-CLIN structure identified in the con-tract and task order.

c) The invoice shall list, in part, the following:

1. Task order number

2. Task order’s maximum quantity/ceiling value

3. Task order obligated dollar amount

4. Billed total for the CLIN (for the task order)

5. Task order-year-to-date billed

6. Task order-year-to-date paid by Government

7. Task order cumulative billed (since task order effective date)

8. Task order cumulative paid by Government (since task order effective date)

d) For fixed-price arrangements (i.e., task orders or line items in a task order) when payment is made not based on actual costs in-curred, the Contractor shall submit the monthly apportionment of the awarded fixed-price. The monthly apportionment shall be the awarded fixed-price for the task order period divided by the number of months in the task order period. For example, if a task order in-cludes a base period of one year, the monthly apportionment during the base period shall be the awarded fixed-price for the base peri-od divided by 12 months.

6.4 NON-PAYMENT FOR UNAUTHORIZED WORK

No payments will be made for any unauthorized services or supplies, or for any unauthorized changes to the work specified herein.

This includes any services performed by the Contractor of its own volition or at the request of an individual other than a duly appoin-ted Contracting Officer.